Senator Patrick M. Gallivan, (R-C, Elma) is co-sponsoring legislation (S.9219) that would amend New York’s public health law and social services law in an effort the strengthen Medicaid accountability. The bill would require the Department of Health (DOH) to establish an enrollment verification system, mandate annual audits of high-risk areas, establish structured payment safeguards, and authorize limited verification tools to confirm service delivery.

Recurring audits have identified preventable Medicaid payment errors, enrollment inaccuracies, and processing weaknesses.

“New York spends more on Medicaid than any other state and we must do more to ensure the program is efficient and effective,” said Senator Gallivan, Ranking Member of the Senate Standing Committee on Health. “This legislation will help identify improper payments, waste and abuse within the program.”

A recent audit by State Comptroller Thomas DiNapoli identified out-of-state Medicaid members and found close to $1.2 billion in managed care payments for members who may have resided outside of New York State. The audit also found that the DOH did not confirm that Medicaid members were New York residents and waited too long to try to recover payments.

The comptroller’s office is recommending the DOH improve practices to verify residency, identify members living outside the state, and recover improper premium payments.

The proposed legislation has been sent to the Senate’s Health Committee for review.

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